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Quick reference medical handouts used
by Pediatric offices

Excessive DroolingCauses and Treatment

Definition

It is normal for babies to drool. As babies grow and mature, they
are better able to take care of their secretions. Most children don't drool
when awake or asleep after the age of 4 years. However, children with
neurological problems have difficulty making their muscles and nerves work
properly. They have trouble swallowing saliva. Drooling is frequently seen
in these children at older ages.

Why should drooling be controlled?

Drooling can irritate the skin of the face, neck, and chest. It can
be embarrassing to the child and can make the child socially less
acceptable.

What are the benefits of saliva?

Saliva is almost all water. There are small amounts of other substances,
such as bicarbonate, sodium, chloride, potassium, and mucous which help the
mouth and body. The mucous helps protect the throat and esophagus from injury
during eating. Saliva also helps recoat the teeth with calcium. It helps
keep gums healthy. It helps remove bacteria from inside the mouth and decreases
breath odor. Saliva contains amylase, an enzyme that begins the digestion
of starches.

What is the cause of drooling?

Saliva comes from three pairs of salivary glands, plus many smaller
glands. All of these are found in the mouth. Two parotid glands are inside
the cheek area. The pair of sublingual glands are under the tongue. The two
submandibular glands are close to the lower jaw.

Adults and children over the age of 8 years make from one half to
one and a half quarts of saliva a day. Younger children can produce as much
as eight times more saliva than adults. Drooling occurs because the saliva
is not swallowed and flows out of the mouth. This usually occurs from improper,
inefficient, or infrequent swallowing. It is unusual for drooling to be caused
from making too much saliva.

How is it treated?

The problem of excessive drooling can be treated in several
ways:

Speech therapy

A speech therapist can help your child learn to close the lips, move
the saliva to the back of the mouth, and swallow. Learning to use a straw
for fluids can improve drooling. Speech therapy is the preferred way to correct
drooling. Helping your child learn the correct way to swallow solves the
problem better than increasing the frequency of swallowing, although the
latter does help a little. Improving posture and body position can also be
helpful. While your child is taking speech therapy, medications are usually
used for immediate improvement.

Medication

The salivary glands are under the control of a part of the nervous
system called the autonomic system. The medicines listed below cause the
body to make less saliva by inhibiting the part of the autonomic system known
as the parasympathetic system. This part of the nervous system also helps
regulate urine output and stomach emptying.

Robinul (glycopyrrolate) is available as a pill. It can be given by
mouth or crushed and put through a gastrostomy site. This medicine does not
cause sleepiness or mood changes.

Scopolamine patches can be used. The entire patch is placed on the
skin for a few hours each day and then removed. A patch has enough medicine
for several days. However, once the patch is put on the skin and then taken
off, it cannot be used again. Since the medicine is not equally distributed
in the patch, the patch should not be cut into smaller pieces. For these
reasons, the use of scopolamine for drooling is somewhat wasteful and expensive.
There is a small chance you child could develop crossed eyes while wearing
the patch. This is reversible when it is removed.

Artane (trihexyphenidyl hydrochloride) comes in either liquid or tablet
form.

Cogentin (benztropine mesylate) comes in tablet form. It can be crushed
and either fed orally or put down a gastrostomy tube.

Surgery/Botulinum injection/Radiotherapy

Surgery involves either changing the direction of the ducts which
lead from the salivary glands to the mouth, or removing the salivary gland
tissue. Using x-rays to destroy part of the salivary glands is reserved for
severe cases.

Laser surgery has recently been used. This treatment allows a quicker
recovery than regular surgery.

Botulinum Toxin A injections are done under anesthesia. The toxin
is injected into the parotid gland. This treatment lasts up to 8 months.
To date this treatment has only been done on adults.

Radiotherapy, or use of x-rays, to destroy part of the salivary glands
is only used in severe cases and not usually used in children.

Alternative Therapies

Biofeedback and hypnotherapy have been used in some patients with
varying amounts of success.

Bibs

Don't forget that bibs are helpful to protect skin and clothing.
The use of bandannas, or a bib that matches the shirt or dress, especially
in older children, can make the bib less noticeable or add a fashion
accent.

As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
Please read our full disclaimer.

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